Impact of device variability and protocol differences on kidney function during normothermic machine perfusion: A comparative study using porcine and human kidneys
Artificial Organs, vol. 49, pp. 93–107
Abstract
INTRODUCTION: A growing interest in renal normothermic machine perfusion (NMP) has resulted in more clinically available perfusion devices. While all perfusion systems have the same aim, there are significant differences in their circuits, pumps, sensors, and software. Therefore, our objective was to assess the impact of different perfusion protocols and devices on kidney function and perfusion parameters during NMP. METHODS: Porcine kidneys were subjected to 30 min of warm ischemia, 24 h of static cold storage, and subsequently perfused for 6 h using (1) the Kidney Assist (KA) machine with a pressure of 75 mm Hg, (2) the KA device incorporating several adjustments and a pressure of 85 mm Hg (modified KA), or (3) the Perlife (PL) perfusion device (n = 4). Consecutively, discarded human kidneys were perfused using the KA or modified KA (n = 3) protocol. RESULTS: was significantly lower in the PL group. Yet, hemoglobin concentration increased over time, and oxygen consumption was significantly higher compared to the KA groups. Fractional sodium excretion was significantly lower in the PL group. Tissue ATP levels, urine production, and creatinine clearance rates did not differ between groups. In human kidneys, the modified KA group showed significantly lower vascular resistance, higher oxygen delivery, and lower levels of lactate in the perfusate compared to the KA group. CONCLUSIONS: This study shows that perfusion characteristics and kidney function are significantly influenced by the perfusion protocol and the device and its settings during normothermic machine perfusion and therefore should be interpreted with caution.
Authors 11
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Veerle A. Lantinga corresponding
University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Asel S. Arykbaeva Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Surgery Leiden University Medical Center Leiden the Netherlands
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Anaesthesiology, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Rutger J. Ploeg Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center
Leiden University Medical Center · University of Oxford
Affiliation as printed
Department of Surgery Leiden University Medical Center Leiden the Netherlands
Nuffield Department of Surgical Sciences University of Oxford Oxford UK
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Ian P.J. Alwayn Aachen Department of Surgery Leiden University Medical Center Leiden the Netherlands Department of Surgery, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Surgery Leiden University Medical Center Leiden the Netherlands
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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University Medical Center Groningen · University of Groningen · Icahn School of Medicine at Mount Sinai
Affiliation as printed
Department of Surgery, University Medical Center Groningen University of Groningen Groningen the Netherlands
Recanati/Miller Transplantation Institute Icahn School of Medicine at Mount Sinai New York City New York USA
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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